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Surgical Outcomes of Pancreaticoduodenectomy for Pancreatic Cancer with Proximal Dorsal Jejunal Vein Involvement

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background/Purpose

The proximal jejunal vein which branches from the dorsal side of the superior mesenteric vein (SMV) usually drains the inferior pancreatoduodenal veins (IPDVs) and contacts the uncinate process of the pancreas. We focused on this vein, termed the proximal dorsal jejunal vein (PDJV), and evaluated the anatomical classification of the PDJV and surgical outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) with PDJV involvement (PDJVI).

Methods

The jejunal veins that branch from the dorsal side of the SMV above the inferior border of the duodenum are defined as PDJVs. We investigated 121 patients who underwent upfront pancreaticoduodenectomy for PDAC between 2011 and 2017; PDJVs were resected in all patients. The anatomical classification of PDJV was evaluated using multidetector computed tomography. Surgical and prognostic outcomes of pancreticoduodenectomy for PDAC with PDJVI were evaluated.

Results

The PDJVs were classified into seven types depending on the position of the first and second jejunal veins relative to the superior mesenteric artery. In all patients, the morbidity and mortality rates were 15.7 and 0.8%, respectively. The rates for parameters including SMV resection, presence of pathological T3–4, R0 resection, and 3-year survival were 46.2, 92.3, 92.3, and 61.1%, respectively, when there was PDJVI (n = 13). When there was no PDJVI (n = 108), the rates were 60.2, 93.5, 86.1, and 58.3%, respectively. Overall, there were no significant differences.

Conclusions

Pancreaticoduodenectomy with PDJV resection is feasible for PDAC with PDJVI and satisfactory overall survival rates are achievable. It may be necessary to reconsider the resectability of PDAC with PDJVI.

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Authors and Affiliations

  1. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Yuichi Hosokawa, Yuichi Nagakawa, Yatsuka Sahara, Chie Takishita, Tetsushi Nakajima, Yosuke Hijikata, Hiroaki Osakabe, Tomoki Shirota, Keiichiro Inoue, Kenji Katsumata & Akihiko Tsuchida

  2. Department of Radiology, Tokyo Medical University, Tokyo, Japan

    Kazuhiro Saito

  3. Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan

    Hiroshi Yamaguchi

  4. Department of Gastroenterological Medicine, Tokyo Medical University, Tokyo, Japan

    Takayoshi Tsuchiya, Atsushi Sofuni & Takao Itoi

Authors
  1. Yuichi Hosokawa
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  2. Yuichi Nagakawa
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  3. Yatsuka Sahara
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  4. Chie Takishita
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  5. Tetsushi Nakajima
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  6. Yosuke Hijikata
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  7. Hiroaki Osakabe
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  8. Tomoki Shirota
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  9. Kazuhiro Saito
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  10. Hiroshi Yamaguchi
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  11. Keiichiro Inoue
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  12. Kenji Katsumata
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  13. Takayoshi Tsuchiya
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  14. Atsushi Sofuni
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  15. Takao Itoi
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  16. Akihiko Tsuchida
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Contributions

Hosokawa Y, Nagakawa Y, and Saito K, Yamaguchi H, Inoue K, Katsumata K, Itoi T, and Tsuchida A were responsible for conception and design of the work. Hosokawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y, Osakabe H, and Shirota T were responsible for data collection. Hosokawa Y, Nagakawa Y, Tsuchiya T, Sofuni A, and Tsuchida A were responsible for data analysis and interpretation of the data. All the authors contributed to drafting the article or revising it critically. In addition, all the authors contributed to the final approval of the version to be published and all the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yuichi Nagakawa.

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The authors declare that they have no conflicts of interest.

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Hosokawa, Y., Nagakawa, Y., Sahara, Y. et al. Surgical Outcomes of Pancreaticoduodenectomy for Pancreatic Cancer with Proximal Dorsal Jejunal Vein Involvement. J Gastrointest Surg 22, 1179–1185 (2018). https://doi.org/10.1007/s11605-018-3722-0

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  • DOI: https://doi.org/10.1007/s11605-018-3722-0

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